Radiation Therapy Effects and Nursing Care

Tumor Antigen - Antibody Complexes

• Immune system may be suppressed through the production of tumor antigen - antibody complexes.
• Tumors can change their appearance and produce substances that impair typical immune responses.
• These substances can promote tumor growth and increase the patient’s susceptibility to infection.

Detection and Prevention of Cancer

• Primary Prevention
  • Educate the community about knowledge and skills for preventing cancer.
  • Assist patients in avoiding known carcinogens.
  • Encourage dietary and lifestyle changes.
• Secondary Prevention
  • Promote genetic screening and cancer risk evaluation.
  • Raise public awareness about health-promoting behaviors, including Pap smears, breast and testicular examinations, and digital rectal examinations.

Diagnosis and related Nursing Considerations

• Patients suspected of having cancer undergo extensive testing to
  • Determine the presence and extent of the tumor.
  • Identify possible metastasis or invasion of other tissues.
  • Evaluate the function of involved and uninvolved body systems and organs.
  • Obtain tissue and cells for analysis including evaluation of tumor stage and grade.
• Patients may experience fear and anxiety during extensive testing and upon receiving results.
• Nurses can alleviate fear and anxiety by explaining:
  • The tests to be performed.
  • Sensations likely to be experienced.
  • The patient’s role in the test procedures.

Tumor Staging

• Staging determines the extent of the tumor and existence of metastasis.
• The TNM system is frequently used:
  • T: Primary tumor extent
  • N: Lymph node involvement
  • M: Extent of metastasis
• TNM system:
  • Tumor (T):
    • T1 = 4cm
    • T4 = Invades the adjacent and deep subjacent area.
  • Nodes (N):
    • N0 = None
    • N1 = Ipsilateral (same side)
    • N2 = Contralateral/bilateral
    • N3 = Fixed palpable
  • Metastasis (M):
    • M0 = None
    • M1 = Distant M
  • If N and M are absent, the stage is determined by the T:
    • • Stage 1 * Stage 4  T1 N0  T1 N2 M0 M0  T2 N2 M0
    • • Stage 2  T3 N2 M0 M0  T2 N0  T1 N3 M0
    • • Stage 3  T3 N3 M0 M0  T2 N3 M0 N0M0  T3  T4 N0 M0 N0M0

Tumor Grading

• Classifies tumor cells.
• Less differentiated cells are more malignant.
• Grade 1: 75-100% well differentiated (best prognosis).
• Grade 2: 50-75%.
• Grade 3: 25-50%.
• Grade 4: 0-25% (most malignant), poorly differentiated.

Management of Cancer

• Cure: Complete eradication of malignant disease.
• Control: Prolonged survival and containment of cancer cell growth.
• Palliation: Relief of symptoms associated with the disease.

Management of Cancer (7)

• Surgery
• Radiation therapy
• Chemotherapy
• Bone Marrow Transplant
• Biologic Response Modifier Therapy
• Photodynamic therapy
• Gene therapy

Surgery

• Surgical removal of the entire cancer is the ideal and most frequently used method.
• Two Types:
  • Diagnostic surgery
  • Surgery as Primary Treatment

Diagnostic Surgery

• biopsy
• Usually performed to obtain a tissue sample for analysis of suspected malignant cells.

Types of Biopsy

• Excisional: Removal of the entire tumor and surrounding tissues.
• Incisional: Removal of a wedge of tissue from the tumor.
• Needle: A small amount of tissue is aspirated through a needle guided into the suspected area.

Surgery as Primary Treatment

• Goal is to remove the entire tumor or as much as possible, including involved tissues and lymph nodes.
• Local excision: Removal of small mass and a small margin of surrounding tissue.
• Radical excision: en bloc removal of the primary tumor, lymph nodes, adjacent structures, and surrounding tissues.
• Salvage surgery: Extensive surgical approach to treat local recurrence after a less extensive primary approach.

Other Surgical Interventions

• Electrosurgery: Uses electrical current to destroy tumor cells.
• Cryosurgery: Uses liquid nitrogen to freeze and destroy tissue.
• Chemosurgery: Combined chemotherapy and surgical removal of tissue.
• Laser surgery: Uses light and energy to vaporize cancer cells.
• Stereotactic radiosurgery (SRS): Single, precise administration of high-dose radiation therapy.

Laparoscopic Electrosurgery

• Minimally invasive surgery using optical and surgical instruments through small incisions.
• Limited field of vision may cause undetected burns outside the surgeon's view, potentially leading to infection.

Cryosurgery

• Treatment for prostate cancer using cryoprobes inserted into the prostate gland.
• Probes are precisely placed using ultrasound guidance, and temperature sensors are used to ensure tissue freezing.
• Procedure is performed under spinal anesthesia.

Advantages of Cryosurgery for Prostate Cancer

• Minimally invasive procedure.
• Favorable success rate and complication rates.
• Short recuperation period.
• Repeatable if the first cryoablation fails.
• Radiation therapy or prostatectomy is still an option if the procedure fails.
• Less expensive than traditional treatment.

Disadvantages of Cryosurgery for Prostate Cancer

• Suprapubic urinary catheter for 2-3 weeks after the procedure.
• Initial impotence after the procedure, which may improve over time.

Chemosurgery

• Also called chemical peels.
• Uses a chemical solution to remove damaged skin.
• Helps restore wrinkled, sun-damaged, and blemished skin.

Stereotactic Radiosurgery

• Non-surgical treatment using focused beams of radiation on small, deep tumors or lesions.

Nursing Management in Cancer Surgery

• Respond to patient and family questions about diagnostic testing results based on physician information.
• Provide education and emotional support by assessing patient and family needs and exploring their fears and coping mechanisms.
• Encourage active participation in decision-making when possible.
• Monitor post-operative responses for complications such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid/electrolyte imbalance, and organ dysfunction.
• Provide comfort measures.
• Provide post-operative teaching related to:
  • Wound care
  • Activity
  • Nutrition
  • Medication information
• Plan for discharge, follow-up, home care, and treatment for continuity of care.

Radiation Therapy

• Uses ionizing radiation to interrupt cellular growth.
• Used to:
  • Control malignant disease when a tumor can’t be removed surgically.
  • Treat local nodal metastasis.
  • Prevent leukemic infiltration into the brain or spinal cord.
• Cells are most vulnerable to radiation during DNA synthesis and mitosis.
• Tissues with frequent cell division are most sensitive:
  • Bone marrow
  • Lymphatic tissue
  • Epithelium of the GI tract
  • Hair cells
  • Gonads
• Radiosensitive tumor: Can be destroyed by a dose of radiation that still allows for cell regeneration in normal tissue.

Types of Radiation Therapy

• External radiation: X-rays used to destroy cells at the skin surface or deeper in the body. High energy for deeper penetration.
• Internal radiation: Radioactive isotope inserted into applicators for a prescribed period.

Radiation Therapy Toxicity

• Increased when concurrent chemotherapy is administered.
• Altered skin integrity is common:
  • Alopecia
  • Erythema
  • Desquamation
  • Xerostomia
  • Loss of taste
  • Dysphagia
  • Thrombocytopenia
  • Leukopenia
  • Fatigue, malaise, anorexia

Nursing Management in Radiation Therapy

• Explain the procedure, equipment, duration, immobilization needs, and absence of sensation during the procedure.
• If radioactive implants are used, inform the patient and family about visitor and personnel restrictions and other radiation procedures.

Protecting the Skin & Oral Mucosa

• Assess patient’s skin, nutritional status, and well-being.
• Monitor skin and oral mucosa frequently for changes.
• Protect the skin from irritation and instruct the patient to avoid using ointments, lotions, or powders on the area.
• Ensure gentle oral hygiene to remove debris, prevent irritation, and promote healing.
• Offer reassurance by explaining that symptoms are a result of treatment and do not indicate disease progression.

Safety Precautions for Radiation Exposure

• Patient should be in a private room.

Chemotherapy

• Scientists have yet to identify features of malignant and immune cells that make them uniquely targetable.
• Hair growth and intestinal epithelium are severely affected.
• Causes fear due to potential severe side effects.
• Used when cancer has metastasized. Treats systemic disease rather than localized lesions.
• Often used in combination treatments
• Can be administered in a hospital, clinic, or home setting.
• Routes:
  • Topical, oral
  • IV, IM, SQ
  • Arterial, intracavitary, intrathecal

Special Problems with Chemotherapy

• Extravasation:
  • Special care is needed when administering vesicants intravenously.
  • Vesicants cause tissue necrosis if deposited into the subcutaneous tissue.
  • Only trained physicians and nurses should administer vesicants.
  • If extravasation is suspected, stop administration, apply ice (unless the vesicant is a vinca alkaloid), aspirate the vesicant, and inject a neutralizing solution.

Classification of Chemotherapeutic Agents

• Antitumor Antibiotics

  • Interfere with DNA synthesis by binding DNA.
  • Prevent RNA synthesis.
  • Common side effects: BM suppression, nausea, vomiting, alopecia, anorexia, cardiac toxicity.

• Mitotic Spindle Poisons

  • Plant Alkaloids
    • Arrest metaphase by inhibiting mitotic tubular formation.
    • Common side effects: BM suppression, neuropathies, stomatitis.
  • Taxanes
    • Arrest metaphase by inhibiting tubulin depolymerization.
    • Common side effects: Bradycardia, hypersensitivity, BM suppression, alopecia, neuropathies.

• Hormonal Agents

  • Bind to hormone receptor sites that alter cellular growth.
  • Block binding of estrogens to receptors and inhibit RNA synthesis.
  • Common side effects: Hypercalcemia, jaundice, increased appetite, masculinization, feminization, sodium/fluid retention, nausea, vomiting, vaginal dryness, hot flashes.